Provider Demographics
NPI:1649409582
Name:SPECIALTY SURGERY ANESTHESIOLOGY, LLC
Entity Type:Organization
Organization Name:SPECIALTY SURGERY ANESTHESIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMOROSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-531-7246
Mailing Address - Street 1:215 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1540
Mailing Address - Country:US
Mailing Address - Phone:732-531-7246
Mailing Address - Fax:
Practice Address - Street 1:74 BRICK BLVD
Practice Address - Street 2:BRICK PAVILLION BLDG 3
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7984
Practice Address - Country:US
Practice Address - Phone:732-262-0700
Practice Address - Fax:732-262-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04142300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2058308Medicaid
NJ2058308Medicaid